Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 3/2011

01.03.2011 | Colorectal Cancer

Outcome Standards for an Organ Preservation Strategy in Stage II and III Rectal Adenocarcinoma after Neoadjuvant Chemoradiation

verfasst von: Albert M. Wolthuis, MD, Freddy Penninckx, MD, PhD, Karin Haustermans, MD, PhD, Nadine Ectors, MD, PhD, Eric Van Cutsem, MD, PhD, André D’Hoore, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 3/2011

Einloggen, um Zugang zu erhalten

Abstract

Background

Neoadjuvant chemoradiotherapy is the standard of care for patients with locally advanced mid and distal rectal cancer. Tumor regression is variable, and this study was designed to evaluate the pathological response and impact on long-term disease control in responders and nonresponders.

Methods

A total of 303 consecutive patients with cStage II and III mid and distal rectal adenocarcinoma were identified. The mean age was 64 years and 63% were men. Patients received neoadjuvant chemoradiotherapy (45 Gy) with a continuous infusion of 5-fluorouracil. Total mesorectal excision (TME) was performed after an interval of 6–8 weeks. Tumors were stratified as responders (ypT0 or ypT1) and nonresponders (≥ypT3). All ypT2 were separately categorized.

Results

Tumors of 84 patients were classified as responders (27.5%) versus nonresponders in 144 patients (47.5%). Pathological tumor stage was ypT2 in 75 patients (25%). After a median follow-up of 55 months, the 5-year cancer-specific survival rate was 98% and the disease-free survival rate was 91% in responders versus 82% (P < 0.0025) and 60% (P < 0.0001), respectively, for the nonresponders.

Conclusions

After neoadjuvant chemoradiotherapy and TME surgery for locally advanced rectal cancer and complete or near-complete pathological tumor response oncological outcome is very good. These results set the standards for a rectum-sparing strategy.
Literatur
1.
Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.PubMedCrossRef
2.
Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336:980–7.CrossRef
3.
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al.; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.PubMedCrossRef
4.
Bosset JF, Collette L, Calais G, et al. EORTC Radiotherapy Group Trial 22921. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114–23.PubMedCrossRef
5.
Peeters KC, Marijnen CA, Nagtegaal ID, et al.; Dutch Colorectal Cancer Group. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007;246:693–701.PubMedCrossRef
6.
Roh MS, Colangelo LH, O’Connell MJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol. 2009;27:5124–30.PubMedCrossRef
7.
Platell C, Barwood N, Dorfmann G, Makin G. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis. 2006;9:71–9.CrossRef
8.
Marijnen CA, van de Velde CJ, Putter H, et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2005;23:1847–58.PubMedCrossRef
9.
Brown CJ, Fenech DS, McLeod RS. Reconstructive techniques after rectal resection for rectal cancer. Cochrane Database Syst Rev. 2008;2:006040.PubMed
10.
Parc Y, Zutshi M, Zalinski S, Ruppert R, Fürst A, Fazio VW. Preoperative radiotherapy is associated with worse functional results after coloanal anastomosis for rectal cancer. Dis Colon Rectum. 2009;52:2004–14.PubMed
11.
Kim NK, Aahn TW, Park JK, Lee KY, Lee WH, Sohn SK, Min JS. Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer. Dis Colon Rectum. 2002;45:1178–85.PubMedCrossRef
12.
Junginger T, Kneist W, Heintz A. Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision. Dis Colon Rectum. 2003;46:621–8.PubMedCrossRef
13.
Hendren SK, O’Connor Bl, Liu M, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg. 2005;242:212–23.PubMedCrossRef
14.
Moriya Y. Function preservation in rectal cancer surgery. Int J Clin Oncol. 2006;11:339–43.PubMedCrossRef
15.
Habr-Gama A, Perez RO, Proscurshim I, Campos FG, Nadalin W, Kiss D, Gama-Rodrigues J. Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg. 2006;10:1319–28.PubMedCrossRef
16.
Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240:711–7.PubMed
17.
Lezoche E, Guerrieri M, Paganini AM, Baldarelli M, De Sanctis A, Lezoche G. Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg. 2005;92:1546–52.PubMedCrossRef
18.
Borschitz T, Wachtlin D, Möhler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol. 2008;15:712–20.PubMedCrossRef
19.
Berger C, De Muret A, Garaud P, et al. Preoperative radiotherapy (RT) for rectal cancer: prognostic factors of tumor downstaging and residual tumor cell density (RTCD): Prognostic implications. Int J Radiat Oncol Biol Phys. 1997;37:619–27.PubMedCrossRef
20.
Kaminsky-Forrett MC, Conroy T, Luporsi E, et al. Prognostic implications of downstaging following preoperative radiation therapy for operable T3-T4 rectal cancer. Int J Radiat Oncol Biol Phys. 1998;42:935–41.PubMedCrossRef
21.
Janjan NA, Abbruzzese J, Pazdur R, et al. Prognostic implications of response to preoperative infusional chemoradiation in locally advanced rectal cancer. Radiother Oncol. 1999;51:153–60.PubMedCrossRef
22.
Onaitis MW, Noone RB, Fields R, et al. Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival. Ann Surg Oncol. 2001;8:801–6.PubMedCrossRef
23.
Theodoropoulos G, Wise WE, Padmanabhan A, Kerner BA, Taylor CW, Aguilar PS, Khanduja KS. T-Level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer results in decreased recurrence and improved disease-free survival. Dis Colon Rectum. 2002;45:895–903.PubMedCrossRef
24.
Ruo L, Tickoo S, Klimstra D, et al. Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg. 2002;236:75–81.PubMedCrossRef
25.
Valentini V, Coco C, Picciocchi A, et al. Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys. 2002;53:664–74.PubMedCrossRef
26.
Garcia-Aguilar J, de Handa EH, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum. 2003;46:298–304.PubMedCrossRef
27.
Reerink O, Verschueren RCJ, Szabo BG, Hospers GA, Mulder NH. A favourable pathological stage after neoadjuvant radiochemotherapy in patients with initially irresectable rectal cancer correlates with a favourable prognosis. Eur J Cancer. 2003;39:192–5.PubMedCrossRef
28.
Brown CL, Ternent CA, Thorson AG, Christensen MA, Blatchford GJ, Shashidharan M, Haynatzki GR. Response to preoperative chemoradiation in stage II and III rectal cancer. Dis Colon Rectum. 2003;46:1189–93.PubMedCrossRef
29.
Rödel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23:8688–96.PubMedCrossRef
30.
Vecchio FM, Valentini V, Minsky B, et al. The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys. 2005;62:752–60.PubMedCrossRef
31.
Chapet O, Romestaing P, Mornex F, et al. Preoperative radiotherapy for rectal adenocarcinoma: Which are strong prognostic factors? Int J Radiat Oncol Biol Phys. 2005;61:1371–7.PubMedCrossRef
32.
Chan AKP, Wong A, Jenken D, Heine J, Buie D, Johnson D. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys. 2005;61:665–77.PubMedCrossRef
33.
Habr-Gama A, Perez RO, Nadalin W, et al. Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival. J Gastrointest Surg. 2005;9:90-9; discussion 99–101.PubMedCrossRef
34.
Stipa F, Chessin DB, Shia J, et al. A pathologic complete response of rectal cancer to preoperative combined-modality therapy results in improved oncological outcome compared with those who achieve no downstaging on the basis of preoperative endorectal ultrasonography. Ann Surg Oncol. 2006;13:1047–53.PubMedCrossRef
35.
Vestermark LW, Jacobsen A, Qvortrup C, et al. Long-term results of a phase II trial of high-dose radiotherapy (60 Gy) and UFT/l-leucovorin in patients with non-resectable locally advanced rectal cancer (LARC). Acta Oncol. 2008;47:428–33.PubMedCrossRef
36.
Lindebjerg J, Spindler KL, Ploen J, Jakobsen A. The prognostic value of lymph node metastases and tumor regression grade in rectal cancer patients treated with long-course preoperative chemoradiotherapy. Colorectal Dis. 2009;11:264–9.PubMedCrossRef
37.
Pucciarelli S, Gagliardi G, Maretto I, et al. Long-term oncologic results and complications after preoperative chemoradiotherapy for rectal cancer: a single-institution experience after a median follow-up of 95 months. Ann Surg Oncol. 2009;16:893–9.PubMedCrossRef
38.
Weiser MR, Landmann RG, Wong WD, et al. Surgical salvage of recurrent rectal cancer after transanal excision. Dis Colon Rectum. 2005;48:1169–75.PubMedCrossRef
39.
Perez RO, Habr-Gama A, Proscurshim I, Campos FG, Kiss D, Gama-Rodrigues J, Cecconello I. Local excision for ypT2 rectal cancer-much ado about something. J Gastrointest Surg. 2007;11:1431–8; discussion 1438–40.PubMedCrossRef
40.
Sanghera P, Wong DW, McConkey CC, Geh JI, Hartley A. Chemoradiotherapy for rectal cancer: an updated analysis of factors affecting pathological response. Clin Oncol (R Coll Radiol). 2008;20:176–83.
Metadaten
Titel
Outcome Standards for an Organ Preservation Strategy in Stage II and III Rectal Adenocarcinoma after Neoadjuvant Chemoradiation
verfasst von
Albert M. Wolthuis, MD
Freddy Penninckx, MD, PhD
Karin Haustermans, MD, PhD
Nadine Ectors, MD, PhD
Eric Van Cutsem, MD, PhD
André D’Hoore, MD, PhD
Publikationsdatum
01.03.2011
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 3/2011
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1324-5

Weitere Artikel der Ausgabe 3/2011

Annals of Surgical Oncology 3/2011 Zur Ausgabe

Colorectal Cancer

Loss of E-cadherin and MUC2 Expressions Correlated with Poor Survival in Patients with Stages II and III Colorectal Carcinoma

Translational Research and Biomarkers

Role of Survivin Gene Promoter Polymorphism (−31G>C) in Susceptibility and Survival of Esophageal Cancer in Northern India

Colorectal Cancer

Sentinel Node Biopsy by Indocyanine Green Retention Fluorescence Detection for Inguinal Lymph Node Staging of Anal Cancer: Preliminary Experience

Thoracic Oncology

Thoracoscopic Esophagectomy in Prone Position

Pancreatic Tumors

Borderline Resectable Pancreatic Cancer: What Have We Learned and Where Do We Go From Here?

Translational Research and Biomarkers

Regarding: Epithelial-Mesenchymal Transition Induced by Hepatitis C Virus Core Protein in Cholangiocarcinoma

Neu im Fachgebiet Chirurgie

16.04.2024 | Infektiologie | Nachrichten

Kein Abstrich bei chronischen Wunden ohne Entzündungszeichen!

10.04.2024 | Postoperative Schmerztherapie | Nachrichten

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente

10.04.2024 | Narbenhernie | Nachrichten

Deutlich weniger Narbenhernien mit der Small-Bites-Technik

09.04.2024 | Appendektomie | Nachrichten

Appendektomie: Vorsicht bei systemischen Glukokortikoiden!
weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom CME-Kurs
CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur CME-Kurs
CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis CME-Kurs
CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.